Delivery of polypeptides by secretory gland expression

ABSTRACT

The invention features methods for delivering a polypeptide to the bloodstream of a subject by introduction of a nucleic acid construct into secretory gland cells(e.g., cells of salivary gland, pancreas, or liver). In general, the method involves introduction of a nucleic acid construct into a secretory gland duct, which introduction results in expression of a gene product encoded by the introduced construct and delivery of the gene product into the bloodstream of the subject.

CROSS-REFERENCE TO RELATED APPLICATIONS

[0001] This application is a continuation-in-part of U.S. application Ser. No. 09/130,888, filed Aug. 7, 1998, which is a continuation of U.S. application Ser. No. 08/591,197, filed Jan. 16, 1996, which is a continuation-in-part of U.S. application Ser. No. 08/410,660, filed Mar. 24, 1995, which applications are incorporated herein by reference.

FIELD OF THE INVENTION

[0002] This invention relates generally to delivery of a substance to the bloodstream of a subject, in particular to bloodstream-directed delivery of a polypeptide.

BACKGROUND OF THE INVENTION

[0003] The ability to replace defective or absent genes has attracted wide attention as a method to treat a variety of human diseases (Crystal 1995 Science 270:404), Lever et al. 1995 Gene Therapy. Pearson Professional, New York p. 1-91; Friedmann 1996 Nature Med. 2:144). Although originally intended as a means of correcting inherited disorders in certain populations of somatic cells, gene-based therapy can be a useful means to supply exogenous gene products to the circulatory system for the treatment of a wide range of systemic disorders that involve deficiencies in circulating proteins, such as hormones, growth factors, and clotting proteins (Lever et al. 1995 supra; Buckel 1996 TiPS 17:450), as well as a means of administering other polypeptide drugs. The success of this application depends upon developing effective methods to both manufacture the desired protein in vivo and then secrete it into blood (Crystal 1995 supra; Lever et al. 1995 supra).

[0004] Currently, DNA-based therapy (i.e., gene therapy) is carried out in a variety of ways but involves two general protocols. In the first method, referred to as ex vivo gene therapy, cells are extracted from an individual and subjected to genetic manipulation. After genetic material has been properly inserted into the cells, the cells are implanted back into the individual from which they were removed. Persistent, in vivo expression of the newly implanted genetic material after transplantation of the transformed cells has been successful (see Morgan et al., Science 237:1476 (1987); and Gerrard et al., Nat. Genet. 3:180 (1993)). In the second approach to DNA-based therapy, referred to as in vivo gene therapy, cells within a living organism are transformed in situ with exogenous genetic material.

[0005] Several different methods for transforming cells can be used in accordance with either the ex vivo or in vivo transfection procedures. For example, various mechanical methods can be used to deliver the genetic material, including the use of fusogenic lipid vesicles (liposomes incorporating cationic lipids such as lipofection; see Felgner et al., Proc. Natl. Acad. Sci. U.S.A. 84:7413-7417 (1987)); direct injection of DNA (Wolff, et al., Science (1990) 247:1465-1468); and pneumatic delivery of DNA-coated gold particles with a device referred to as the gene gun (Yang et al., Proc. Natl. Acad. Sci. U.S.A. 1990; 87:1568-9572). Morsy et al. reviews several of the different techniques useful in transformation of cells ex vivo or in vivo and provides citations of numerous publications in each area (Morsy et al., JAMA 270:2338-2345 (1993)).

[0006] One method of particular interest for delivery of genetic material involves use of recombinant viruses to infect cells in vivo or ex vivo. In these methods, a virus containing the desired genetic material is allowed to infect target cells within the subject. Upon infection, the virus injects its genetic material into the target cells. The genetic material is then expressed within the target cell, providing for expression of the desired genetic material. However, it would be preferable to avoid introduction of the desired genetic material by viral infection for a number of reasons. For example, viral infection results in delivery of viral DNA in addition to the desired genetic material, which may in turn result in undesirable cellular effects such as, adverse immune reactions, productive viral replication, and adverse integration events.

[0007] There is a need in the field for a method for delivery of genetic material into a cell in vivo to provide for expression of the introduced polynucleotide and secretion of the gene product it encodes into the bloodstream. The present invention addresses this problem.

SUMMARY OF THE INVENTION

[0008] The invention features methods for delivering a polypeptide to the bloodstream of a subject by introduction of a nucleic acid construct into secretory gland cells(e.g., cells of salivary gland, pancreas, or liver). In general, the method involves introduction of a nucleic acid construct into a secretory gland duct, which introduction results in expression of a gene product encoded by the introduced construct and delivery of the gene product into the bloodstream of the subject.

[0009] A primary object is to provide a method of delivering a polypeptide to the bloodstream of a subject by introducing a nucleic acid construct into cells of a secretory gland, e.g., liver, pancreatic or salivary gland (e.g., parotid gland) cells, preferably by introduction of the construct into a duct of a secretory gland. The secretory gland cells subsequently express a biologically active protein, which protein is secreted into the circulatory system.

[0010] Another object is to provide a non-invasive method of protein delivery (i.e., the method involves introduction of the nucleic acid of interest from outside the body (i.e., from the duct system of particular glands) wherein cells of a secretory gland, preferably the pancreas, salivary gland, or liver of a mammal are genetically modified to express a biologically active and therapeutically useful polypeptide, which polypeptide is secreted into the circulatory system of the individual.

[0011] Another object is to produce genetically transformed secretory gland cells which cells have incorporated into their genome genetic material which, when expressed, produces a biologically active and therapeutically useful protein which is secreted into the circulatory system.

[0012] An advantage of the present invention is that polypeptides can be delivered into the bloodstream on either a long term basis (e.g., by repeated administration of the construct) or on a short term basis. Thus, the invention is useful for treatment of diseases or conditions wherein individuals are suffering from a deficiency in a particular protein and/or can benefit from administration of an exogenous protein having a desired activity (e.g, antimicrobial activity).

[0013] Another advantage of the invention is that, in one embodiment, the nucleic acid constructs can be introduced for expression in a secretory gland cell without the need to contain the construct within a virion (e.g., the method does not require the use of a viral vector containing the construct to introduce the nucleic acid of interest into the secretory gland cell).

[0014] These and other objects, advantages and features of the present invention will become apparent to those persons skilled in the art upon reading the details of the vectors, cell lines and methodology as more fully set forth below.

BRIEF DESCRIPTION OF THE DRAWING

[0015]FIG. 1 is a schematic view of pBAT14hins construct useful in producing recombinant insulin in secretory gland cells according to the invention;

[0016]FIG. 2 is a map of the pFGH construct, which contains the human growth hormone genomic sequence;

[0017]FIG. 3 is a map of the pFGH.CMV construct, which contains the human growth hormone genomic sequence operably linked to the CMV promoter;

[0018]FIG. 4 is a map of the pFGH.chymo construct, which contains the human growth hormone genomic sequence operably linked to the chymotrypsin B promoter;

[0019]FIG. 5 is a graph showing tissue expression of hGH following transformation of salivary gland cells by intraductal introduction.

[0020]FIG. 6 is a graph showing regulation of plasma levels of recombinant hGH expressed from salivary gland cells.

[0021]FIG. 7 is graph showing the relative levels of hGH expression in salivary gland tissue in rats that received either no DNA (control rats), pFGH.CMV, pFGH.CMV premixed with lipofectin, or pFGH.CMV premixed with adenovirus.

[0022]FIG. 8 is a graph showing the levels of tissue expression of human growth hormone expression in the pancreas of rats after intraductal retrograde introduction with either a control containing no DNA or a test sample containing a human growth hormone construct;

[0023]FIG. 9 is a graph showing the serum levels of human growth hormone in rats after intraductal retrograde introduction into the pancreas with either a control containing no DNA or a test sample containing a human growth hormone construct; and

[0024]FIG. 10 is a graph showing the correlation between pancreatic tissue expression and serum levels of human growth hormone.

[0025]FIG. 11 is a graph showing regulation of plasma levels of recombinant hGH expressed from pancreatic cells.

[0026]FIG. 12 is a map of the pBAT16.hInsG1.M2 construct, which contains DNA encoding an altered form of human insulin.

[0027]FIG. 13 is a graph showing the glucose response in streptozotocin-treated rats having pancreatic cells transformed with either human insulin (open bars) or green fluorescent protein (GFP; striped bars).

[0028]FIG. 14 is a graph showing the blood glucose levels in control rats (mock-treated; closed squares), streptozotocin-treated rats (open squares), and streptozotocin rats treated by transformation of pancreatic cells with DNA encoding human insulin (closed circles).

[0029]FIG. 15 is a graph showing the relative amounts of hGH in the pancreatic tissue of rats that received either pFGH (control), pFGH.chymo, pFGH.RSV, pFGH.RSV, or pFGH.CMV by intraductal administration to the pancreas.

[0030]FIG. 16 is a graph showing the relative amounts of hGH in the pancreatic tissue of rats that received either no DNA (mock-transformed), pFGH.CMV, pFGH.CMV premixed with lipofectin, or pFGH.CMV premixed with adenovirus.

[0031]FIG. 17 is a graph showing the relative levels of plasma hGH in rats that received either pFGH (control), pFGH.chymo, pFGH.RSV, pFGH.RSV, or pFGH.CMV by intraductal administration to the pancreas.

[0032]FIG. 18 is a graph showing the relative amounts of plasma hGH in rats that received either no DNA (mock-transformed), pFGH.CMV, pFGH.CMV premixed with lipofectin, or pFGH.CMV premixed with adenovirus by intraductal administration to the pancreas.

[0033]FIG. 19 is a graph showing the blood glucose levels of streptozotocin-treated rats (diabetic) that received either no DNA (open squares) or received human insulin-encoding DNA by intraductal administration into the pancreas (closed squares) over a three day period.

[0034]FIG. 20 is a graph showing the plasma insulin levels of streptozotocin-treated rats (diabetic) that received either no DNA (open squares) or received human insulin-encoding DNA by intraductal administration into the pancreas (closed squares) over a three day period.

[0035]FIG. 21 is a graph showing the blood glucose levels (over a six day period) of streptozotocin-treated rats (diabetic) that received either no DNA (open squares) or received human insulin-encoding DNA by intraductal administration into the pancreas (closed squares).

[0036]FIG. 22 is a graph showing expression of hGH in the plasma of control rats (no DNA) and of rats in which hGH-encoding DNA was introduced into the liver by intraductal administration.

[0037]FIG. 23 is a graph showing stimulation of hGH secretion into the plasma of rats that received hGH-encoding DNA by intraductal injection into the pancreas.

[0038]FIG. 24 is a graph showing the relative levels of plasma hGH in rats that received no DNA (control), received hGH-encoding DNA via intraductal delivery to the liver, received hGH-encoding DNA via intraductal delivery to the pancreas, or received hGH-encoding DNA via intraductal delivery to both the liver and pancreas.

[0039]FIG. 25 is a graph showing the relative levels of hGH expression in pancreas tissue following administration of DNA to both pancreas and liver or to pancreas alone. The graph shows tissue levels of hGH after administration of a control (no DNA) to both pancreas and liver (left-most bar); administration of pFGH.CMV to both pancreas and liver (center bar); and pFGH.CMV to pancreas alone (right-most bar). Adenovirus was admixed with the construct as an adjuvant.

DETAILED DESCRIPTION OF THE INVENTION

[0040] Before the present method of genetically transforming secretory gland cells and methods for delivering a polypeptide to the bloodstream of a subject are described, it is to be understood that this invention is not limited to the particular methodology, protocols, cell lines, secretory glands, vectors and reagents described as such may, of course, vary. It is also to be understood that the terminology used herein is for the purpose of describing particular embodiments only, and is not intended to limit the scope of the present invention which will be limited only by the appended claims.

[0041] It must be noted that as used herein and in the appended claims, the singular forms “a”, “and”, and “the” include plural referents unless the context clearly dictates otherwise. Thus, for example, reference to “a secretory gland cell” includes a plurality of such cells and reference to “the transformation vector” includes reference to one or more transformation vectors and equivalents thereof known to those skilled in the art, and so forth.

[0042] Unless defined otherwise, all technical and scientific terms used herein have the same meaning as commonly understood to one of ordinary skill in the art to which this invention belongs. Although any methods, devices and materials similar or equivalent to those described herein can be used in the practice or testing of the invention, the preferred methods, devices and materials are now described.

[0043] All publications mentioned herein are incorporated herein by reference for the purpose of describing and disclosing the cell lines, vectors, and methodologies which are described in the publications which might be used in connection with the presently described invention.

[0044] Definitions

[0045] By “secretory gland” is meant an aggregation of cells specialized to secrete or excrete materials not related to their ordinary metabolic needs. Secretory glands include salivary glands, pancreas, mammary glands, thyroid gland, thymus gland, pituitary gland, liver, and other glands well known in the art.

[0046] By “exocrine gland” is meant a ducted gland or portion of a ducted gland that releases its products externally relative to the body, e.g., either into the internal cavities such as the ocular and nasal cavities, the lumen of the gastrointestinal tract, or onto the surface of the body.

[0047] By “salivary gland” is meant a gland of the oral cavity which secretes saliva, including the glandulae salivariae majores of the oral cavity (the parotid, sublingual, and submandibular glands) and the glandulae salivariae minores of the tongue, lips, cheeks, and palate (labial, buccal, molar, palatine, lingual, and anterior lingual glands).

[0048] By “pancreas” is meant a large, elongated, racemose gland situated transversely behind the stomach, between the spleen and the duodenum. The pancreas is composed of an endocrine portion (the pars endocrina) and an exocrine portion (the pars exocrina). The pars endocrina, which contains the islets of Langerhans, produces and secretes proteins, including insulin, directly into the bloodstream. The pars exocrina contains secretory units and produces and secretes a pancreatic juice, which contains enzymes essential to digestion, into the duodenum.

[0049] By “transformation” is meant a permanent or transient genetic change induced in a cell following incorporation of new DNA (i.e., DNA exogenous to the cell).

[0050] By “transfection” is meant the transformation of a cell with DNA from a virus.

[0051] By “transformed cell” is meant a cell into which (or into an ancestor of which) has been introduced, by means of recombinant DNA techniques, a DNA molecule encoding a protein of interest.

[0052] By “nucleic acid of interest” is meant any DNA or RNA molecule which encodes a polypeptide or other molecule which is desirable for administration to a mammalian subject for expression of the product encoded by the nucleic acid of interest and delivery of the encoded product into the bloodstream of the mammalian subject. The nucleic acid is generally operatively linked to other sequences which are needed for its expression such as a promoter. The term “DNA of interest” is used to refer to the nucleic acid of interest.

[0053] By “vector” is meant any compound, biological or chemical, which facilitates transformation of a target cell (e.g., a secretory gland cell) with a DNA of interest. Exemplary biological vectors include viruses, particularly attenuated and/or replication-deficient viruses. Exemplary chemical vectors include lipid complexes and naked DNA constructs.

[0054] By “naked DNA” or “naked nucleic acid” or DNA sequence and the like is meant a nucleic acid molecule that is not contained within a viral particle, bacterial cell or other encapsulating means that facilitates delivery of nucleic acid into the cytoplasm of the target cell. Naked nucleic acid can be associated with means for facilitating delivery of the nucleic acid to the site of the target cell (e.g., means that facilitate travel into the target cell of the nucleic acid through the alimentary canal, protect the nucleic acid from stomach acid, and/or serve to penetrate intestinal mucus) and/or to the surface of the target epithelial cell.

[0055] By “promoter” is meant a minimal DNA sequence sufficient to direct transcription.

[0056] “Promoter” is also meant to encompass those nucleic acid elements sufficient for promoter-dependent gene expression controllable for cell-type specific, tissue-specific or inducible by external signals or agents; such elements may be located in the 5′ or 3′ regions of the native gene. By “eukaryotic promoter” is meant a promoter that is functional in eukaryotic cells, which promoters include, but are not limited to, promoters obtained from a eukaryotic gene.

[0057] By “secretory gland specific promoter” is meant a promoter which directs expression of an operably linked DNA sequence when bound by transcriptional activator proteins, or other regulators of transcription, which are unique to a specific type of secretory gland cell. For example, by “salivary gland specific promoter” is meant a secretory gland specific promoter which directs expression in a salivary gland cell. A salivary amylase promoter is an example of a salivary gland specific promoter. By “pancreas specific promoter” is meant a secretory gland specific promoter which directs expression in a pancreatic cell. Examples of pancreas specific promoters include a pancreatic amylase promoter and an insulin promoter.

[0058] By “operably linked” is meant that a DNA sequence and a regulatory sequence(s) are connected in such a way as to permit gene expression when the appropriate molecules (e.g., transcriptional activator proteins) are bound to the regulatory sequence(s).

[0059] By “operatively inserted” is meant that the DNA of interest introduced into the cell is positioned adjacent a DNA sequence which directs transcription and translation of the introduced DNA (i.e., facilitates the production of, e.g., a polypeptide encoded by a DNA of interest).

[0060] By “retrograde ductal introduction” is meant the administration of a liquid or other material into the fluid contents of the duct system of an exocrine gland in a direction opposite to the normal flow of that fluid, either at the external orifice of the duct system or through its wall. “Retrograde ductal introduction” can be a single, discontinuous administration or continuous administration (i.e., perfusion), and can be accomplished by introduction of the material by convection (e.g., infusion), diffusion, or both .

[0061] By “mammalian subject” or “mammalian patient” is meant any mammal for which delivery of a polypeptide or other gene product to the bloodstream is desired, including human, bovine, equine, canine, and feline subjects.

[0062] As used herein, the terms “treatment”, “treating”, and the like, refer to obtaining a desired pharmacologic and/or physiologic effect. The effect may be prophylactic in terms of completely or partially preventing a disease or symptom thereof and/or may be therapeutic in terms of a partial or complete cure for a disease and/or adverse affect attributable to the disease. “Treatment”, as used herein, covers any treatment of a disease in a mammal, particularly in a human, and includes: (a) preventing the disease from occurring in a subject which may be predisposed to the disease but has not yet been diagnosed as having it; (b) inhibiting the disease, i.e., arresting its development; and (c) relieving the disease, i.e., causing regression of the disease. “Treatment” is also mean to encompass delivery of an agent in order to provide for a pharmacologic effect, even in the absence of a disease or condition. For example, “treatment” encompasses delivery of growth factors that can provide for enhanced or desirable effects in the subject (e.g., enhanced milk production in cattle, enhanced weight gain in livestock, etc.).

[0063] By “euglycemia” or “euglycemic state” is meant a state associated with a level of blood glucose that is normal or nearly normal, particularly relative to the levels of blood glucose in a subject having a disease or condition associated with hyperglycemia. In humans, euglycemia correlates with blood glucose levels in the range of 70 mg/dl to 130 mg/dl.

[0064] The terms “synergistic,” “synergistic effect,” and the like are used herein to describe improved effects (e.g., an increase in tissue expression levels in one or more secretory glands, an increased responsiveness to hormonal stimulation to elicit secretion of a polypeptide of interest, or a decrease in an undesirable phenotype) by combining one or more aspects of the invention (e.g., by transformation of more than one secretory gland in a single subject, or by transformation of a secretory gland(s) with multiple constructs encoding the same or different polypeptides).

[0065] Overview of the Invention

[0066] The present invention features methods for delivering a protein to the bloodstream of a subject, and use of such methods to produce genetically altered secretory gland cells. More specifically the invention features methods for delivery of a protein or other product encoded by a nucleic acid sequence of interest to a mammalian subject by expression of a DNA of interest in cells within a secretory gland of a mammalian patient. Preferably, the transformed secretory gland cells expressing the protein encoded by the DNA of interest secrete a therapeutically effective amount of the protein into the bloodstream of the mammalian patient. Preferably, the secretory gland into which the DNA of interest is introduced and expressed is the pancreas, a salivary gland, or the liver. In general, the methods of the invention result in expression of the gene product (e.g., polypeptide) encoded by the construct in secretory gland cells (e.g., acinar cells of the salivary gland, acinar cells of the pancreas, or hepatocytes or parenchymal cells of the liver) to effect delivery of the gene product to the bloodstream. In short, the invention features a delivery system that involves introduction of a nucleic acid sequence encoding a product of interest (e.g., a protein) into a secretory gland cell (e.g., a salivary gland cell, hepatocyte, or pancreatic cell, particularly exocrine cells of salivary gland, liver, or pancreas), expression of the encoded protein, and delivery of the protein into the bloodstream by secretion of the protein by the transformed secretory gland cell.

[0067] In one embodiment of particular interest, the present invention preferably uses either naked DNA or DNA premixed with adjuvants (e.g., lipofectin or viral particles). It is not necessary to incorporate the DNA into viral particles in order to achieve transformation of secretory gland cells and provide expression of the polypeptide of interest at physiologic/therapeutic levels in the bloodstream.

[0068] An important feature of the invention is the use of exocrine cells of glands of the gastrointestinal tract (i.e., pancreas, liver, salivary gland) to produce and secrete therapeutic proteins into blood. While it is well understood that exocrine cells secrete into the lumen of the glands' ducts (i.e. in an exocrine direction), with the exception of the liver (i.e., the hepatocytes secrete cellular products in both directions, e.g. blood proteins into blood and bile salts into the intestinal lumen), it is not widely appreciated that exocrine cells can also secrete significant amounts of protein into the systemic circulation. For example, exocrine proteins such as α-amylase (salivary glands), pepsinogen (gastric glands), various digestive enzymes from the exocrine pancreas, salivary gland kallikreins and nerve growth factor (Liebow, 1988 Pancreas 3:343-351) are normal constituents of blood. In the pancreas, substantial quantities of digestive enzymes are released into the circulation (Saito et al., 1973 Jpn. J. Physiol. 23:477-95; Isenman et al. 1977 Proc. Natl. Acad. Sci (USA) 74:4068-4072; Papp et al. 1980 Acta Physiol. Acad. Sci. Hung. 56:401-410; Geokas et al., 1980 Am. J. Physiol. 238:238-246; Miyasaka et al. 1981 Am. J. Physiol. 241:170-175; Grendell et al. 1982 Am. J. Physiol. 243:54-59). Endocrine secretion can be greatly enhanced by common secretory stimulants (Saito et al., supra; Isenman et al. supra; Miyasaka et al. supra; Grendell et al. supra). As much as 20-25% of the total secreted product can be released into blood as a consequence of stimulation (Grendell et al. supra). The present invention takes advantage of the discovery that exocrine gland cells can be transformed with a desired DNA sequence and secrete the encoded polypeptide into the bloodstream rather than only or primarily into the gastrointestinal tract.

[0069] In addition to the advantages described above, the invention also permits access to the cells of secretory glands without invasive procedures. For example, it is possible to cannulate either the collecting duct of a major salivary gland through its orifice in the mouth, or the common bile or pancreatic duct by means of endoscopic retrograde cholangiopancreatography (ERCP). These are common diagnostic procedures performed on awake patients. The non-invasive methods of the invention allow delivery of the DNA of interest in a safe manner that substantially avoids the inflammatory and immunological responses associated with other means of DNA delivery.

[0070] The invention also takes advantage of the protein-producing capacity of secretory gland cells. This advantage is particularly useful for the production of hormones such as hGH and insulin, which have short half-lives in blood and are cleared quickly. The cells of the exocrine glands are the body's major protein synthesizing and secreting systems. For example, the human exocrine pancreas manufactures and secretes approximately 20 g of protein daily. According to the present invention, even a small proportion of protein synthesized by secretory glands provides enough secreted product to provide therapeutic protein levels for the treatment of most diseases of circulating proteins.

[0071] The invention will now be described in further detail.

[0072] Constructs

[0073] Any nucleic acid construct having a eukaryotic promoter operably linked to a DNA of interest can be used in the invention. The constructs containing the DNA sequence (or the corresponding RNA sequence) which may be used in accordance with the invention may be any eukaryotic expression construct containing the DNA or the RNA sequence of interest. For example, a plasmid or viral construct (e.g. adenovirus) can be cleaved to provide linear DNA having ligatable termini. These termini are bound to exogenous DNA having complementary, like ligatable termini to provide a biologically functional recombinant DNA molecule having an intact replicon and a desired phenotypic property. Preferably the construct is capable of replication in both eukaryotic and prokaryotic hosts, which constructs are known in the art and are commercially available.

[0074] The exogenous (i.e., donor) DNA used in the invention is obtained from suitable cells, and the constructs prepared using techniques well known in the art. Likewise, techniques for obtaining expression of exogenous DNA or RNA sequences in a genetically altered host cell are known in the art (see, for example, Kormal et al., Proc. Natl. Acad. Sci. USA, 84:2150-2154, 1987; Sambrook et al. Molecular Cloning: a Laboratory Manual, 2nd Ed., 1989, Cold Spring Harbor Laboratory Press, Cold Spring Harbor, N.Y.; each of which are hereby incorporated by reference with respect to methods and compositions for eukaryotic expression of a DNA of interest).

[0075] Preferably, the DNA construct contains a promoter to facilitate expression of the DNA of interest within a secretory gland cell. Preferably the promoter is a strong, eukaryotic promoter such as a promoter from cytomegalovirus (CMV), mouse mammary tumor virus (MMTV), Rous sarcoma virus (RSV), or adenovirus. More specifically, exemplary promoters include the promoter from the immediate early gene of human CMV (Boshart et al., Cell 41:521-530, 1985) and the promoter from the long terminal repeat (LTR) of RSV (Gorman et al., Proc. Natl. Acad. Sci. USA 79:6777-6781, 1982). Of these two promoters, the CMV promoter is preferred as it provides for higher levels of expression than the RSV promoter.

[0076] Alternatively, the promoter used may be a tissue-specific promoter. For example, where the secretory gland is the pancreas, the promoter used in the vector may be a pancreas specific promoter, e.g., an insulin promoter or a pancreas α-amylase promoter; where the secretory gland is a salivary gland, the tissue-specific promoter may be a salivary α-amylase promoter or mumps viral gene promoter. Both pancreatic and salivary α-amylase genes have been identified and characterized in both mice and humans (see, for example, Jones et al., Nucleic Acids Res., 17:6613-6623; Pittet et al., J. Mol. Biol., 182:359-365, 1985; Hagenbuchle et al., J. Mol. Biol., 185:285-293, 1985; Schibler et al., Oxf. Surv. Eukaryot. Genes, 3:210-234, 1986; and Sierra et al., Mol. Cell. Biol., 6:4067-4076, 1986 for murine pancreatic and salivary α-amylase genes and promoters; Samuelson et al., Nucleic Acids Res., 16:8261-8276, 1988; Groot et al., Genomics, 5:29-42, 1989; and Tomita et al., Gene, 76:11-18, 1989 for human pancreatic and salivary α-amylase genes and their promoters; Ting et al., Genes Dev. 6:1457-65, 1992 for human salivary α-amylase AMY1C promoter sequences).

[0077] The-constructs of the invention may also include sequences in addition to promoters which enhance secretory gland specific expression. For example, where pancreas specific expression of the DNA of interest is desired, the construct may include a PTF-1 recognition sequence (Cockell et al., Mol. Cell. Biol., 9:2464-2476, 1989). Sequences which enhance salivary gland specific expression are also well known in the art (see, for example, Robins et al., Genetica 86:191-201, 1992).

[0078] Other components such as a marker (e.g., an antibiotic resistance gene (such as an ampicillin resistance gene) or β-galactosidase) to aid in selection of cells containing and/or expressing the construct, an origin of replication for stable replication of the construct in a bacterial cell (preferably, a high copy number origin of replication), a nuclear localization signal, or other elements which facilitate production of the DNA construct, the protein encoded thereby, or both.

[0079] For eukaryotic expression, the construct should contain at a minimum a eukaryotic promoter operably linked to a DNA of interest, which is in turn operably linked to a polyadenylation sequence. The polyadenylation signal sequence may be selected from any of a variety of polyadenylation signal sequences known in the art. Preferably, the polyadenylation signal sequence is the SV40 early polyadenylation signal sequence. The construct may also include one or more introns, which can increase levels of expression of the DNA of interest, particularly where the DNA of interest is a cDNA (e.g., contains no introns of the naturally-occurring sequence). Any of a variety of introns known in the art may be used (e.g, the human β-globin intron, which is inserted in the construct at a position 5′ to the DNA of interest).

[0080] The DNA of interest may be inserted into a construct so that the therapeutic protein is expressed as a fusion protein (e.g., a fusion protein having β-galactosidase or a portion thereof at the N-terminus and the therapeutic protein at the C-terminal portion). Production of a fusion protein can facilitate identification of transformed cells expressing the protein (e.g., by enzyme-linked immunosorbent assay (ELISA) using an antibody which binds to the fusion protein).

[0081] The Nucleic Acid (DNA) of Interest

[0082] The DNA of interest can be any DNA encoding any protein for which intravenous delivery is desirable. For example, intravenous protein delivery is appropriate in, for example, treating a mammalian subject having an inherited or acquired disease associated with a specific protein deficiency (e.g., diabetes, hemophilia, anemia, severe combined immunodeficiency). Such protein deficient states are amenable to treatment by replacement therapy, i.e., expression of a protein to help restore the bloodstream levels of the protein to substantially normal levels.

[0083] Alternatively, the DNA of interest may encode a polypeptide that is either normally present in a healthy mammalian subject or which is foreign to the mammalian subject, and which polypeptide is effective in providing a desired effect (e.g., enhanced weight gain, enhanced growth), in the production of a polypeptide for subsequent isolation (e.g., to produce human proteins in a mammal), and/or treatment of a condition by expression or over-expression of the polypeptide. For example, the DNA of interest can encode antimicrobial, antiparasitic, antifungal, or antiviral polypeptides for treatment of a mammalian subject having a viral (e.g., human immunodeficiency virus (HIV), Epstein-Barr virus (EBV), herpes simplex virus (HSV), bacterial, fungal, and/or parasitic infection, particularly where the infection is chronic, i.e., persisting over a relatively long period of time. The methods of the invention may also be used to enhance expression of a protein present in a normal mammal, or to express a protein not normally present in a normal mammal, in order to achieve a desired effect (e.g., to enhance a normal metabolic process, to provide for a desired immunologic effect (e.g., enhanced immunity or immune responsivity)). For example, a secretory gland of a dairy cow may be transformed with DNA encoding bovine growth hormone (BGH) in order to enhance levels of BGH in the bloodstream and enhance milk production.

[0084] The DNA of interest is preferably obtained from a source of the same species as the mammalian subject to be treated (e.g. human to human), but this is not an absolute requirement. DNA obtained from a species different from the mammalian subject can also be used, particularly where the amino acid sequences of the proteins are highly conserved and the xenogeneic protein is not highly immunogenic so as to elicit a significant, undesirable antibody response against the protein in the mammalian host.

[0085] Exemplary, preferred DNAs of interest include DNA encoding insulin, growth factors (e.g., growth hormone, insulin-like growth factor-1 (IGF-I), platelet-derived growth factor (PDGF), epidermal growth factor (EGF), acidic fibroblast growth factor, basic fibroblast growth factor, or transforming growth factor β), cytokines (e.g., interferon (INF) (e.g., INF-α2b, INF-α2a, INF-αN1, INF-β1b, INF-γ), interleukin (e.g, IL-2, IL-8), or tumor necrosis factor (TNF) (e.g, TNF-α, TNF-β)), clotting factors (e.g., clotting factor VIII), hormones (e.g, GP-1), antimicrobial polypeptides (e.g., antibacterial, antifungal, antiviral, and/or antiparasitic polypeptides), enzymes (e.g., adenosine deaminase), filgastim (Neupogen), hemoglobin, erythropoietin, insulinotropin, imiglucerase, sarbramostim, antigens, tissue plasminogen activator (tPA), urokinase, streptokinase, endothelian, soluble CD4, and antibodies and/or antigen-binding fragments (e.g, FAbs) thereof (e.g., orthoclone OKT-e (anti-CD3), GPIIb/IIa monoclonal antibody). Preferably, the mammalian subject is a human subject and the DNA expressed encodes a human protein.

[0086] Table 1 provides a list of exemplary proteins and protein classes which can be delivered to the bloodstream of a mammalian subject via the method of secretory gland cell transformation of the invention. TABLE 1 Exemplary Proteins and Protein Classes for Expression in and Secretion by Secretory Gland Cells SPECIFIC EXEMPLARY PROTEINS insulin interferon-α2B human growth hormone (hGH) transforming growth factor (TGF) erythropoietin (EPO) ciliary neurite transforming factor (CNTF) clotting factor VIII insulin-like growth factor-1 (IGF-1) bovine growth hormone (BGH) granulocyte macrophage colony stimulating factor (GM-CSF) platelet derived growth factor interferon-α2A (PDGF) clotting factor VIII brain-derived neurite factor (BDNF) thrombopoietin (TPO) insulintropin IL-1 tissue plasminogen activator (tPA) IL-2 urokinase IL-1 RA streptokinase superoxide dismutase (SOD) adenosine deamidase catalase calcitonin fibroblast growth factor (FGF) arginase (acidic or basic) neurite growth factor (NGF) phenylalanine ammonia lyase granulocyte colony stimulating γ-interferon factor (G-CSF) L-asparaginase pepsin uricase trypsin chymotrypsin elastase carboxypeptidase lactase sucrase intrinsic factor calcitonin parathyroid hormone(PTH)- like hormone Ob gene product cholecystokinin (CCK) glucagon insulinotrophic hormone EXEMPLARY CLASSES OF PROTEINS enzymes (e.g., proteases, pituitary hormones phospholipases, etc.) protease inhibitors growth factors cytokines somatomedians chemokines immunoglobulins gonadotrophins interleukins chemotactins interferons lipid-binding proteins

[0087] Numerous proteins that are desirable for intravenous protein therapy are well known in the art and the DNA encoding these proteins has been isolated. For example, the sequence of the DNAs encoding insulin, human growth hormone, intrinsic factor, clotting factor VIII, and erythropoietin are available from Genbank and/or have been described in the scientific literature (e.g., human clotting factor VIII gene: Gitschier et al., Nature 312:326-330, 1984; Wood et al., Nature 312:330-337, 1984; human intrinsic factor: Hewitt et al., Genomics 10:432-440, 1991). Moreover, proteins commonly used in treatments can be used in the procedures of the present invention. Such proteins are disclosed in, for example, the Physicians' Desk Reference (1994 Physicians' Desk Reference, 48th Ed., Medical Economics Data Production Co., Montvale, N.J.; incorporated by reference) and can be dosed using methods described in Harrison's Principles of Internal Medicine and/or the AMA “Drug Evaluations Annual” 1993, all incorporated by reference.

[0088] Where the DNA encoding a protein of interest has not been isolated, this can be accomplished by various, standard protocols well known to those of skill in the art (see, for example, Sambrook et al., ibid; Suggs et al., Proc. Natl. Acad. Sci. USA 78:6613-6617, 1981; U.S. Pat. No. 4,394,443; each of which are incorporated herein by reference with respect to identification and isolation of DNA encoding a protein of interest). For example, genomic or cDNA clones encoding a specific protein can be isolated from genomic or cDNA libraries using hybridization probes designed on the basis of the nucleotide or amino acid sequences for the desired gene. The probes can be constructed by chemical synthesis or by polymerase chain reaction (PCR) using primers based upon sequence data to amplify DNA fragments from pools or libraries (U.S. Pat. Nos. 4,683,195 and 4,683,202). Nucleotide substitutions, deletions, additions, and the like can also be incorporated into the polynucleotides, so long as the ability of the polynucleotide to hybridize is not substantially disrupted. (Sambrook et al. ibid). The clones may be expressed or the DNA of interest can be excised or synthesized for use in other constructs. If desired, the DNA of interest can be sequenced using methods well known in the art.

[0089] It may also be desirable to produce altered forms of the therapeutic proteins that are, for example, protease resistant or have enhanced activity relative to the wild-type protein. For example, where the therapeutic protein is a hormone, it may be desirable to alter the protein's ability to form dimers or multimeric complexes. For example, insulin may be modified so as to prevent its dimerization has a more rapid onset of action relative to wild-type, dimerized insulin.

[0090] Vectors for Delivery of the DNA of Interest to the Secretory Gland Cell

[0091] The vectors for delivery of the DNA of interest can be either viral or non-viral, or may be composed of naked DNA admixed with an adjuvant such as viral particles (e.g, adenovirus) or cationic lipids or liposomes. An “adjuvant” is a substance that does not by itself produce the desired effect, but acts to enhance or otherwise improve the action of the active compound. The precise vector and vector formulation used will depend upon several factors such as the secretory gland targeted for gene transfer.

[0092] Non-Viral Vectors

[0093] The DNA of interest may be administered using a non-viral vector. “Non-viral vector” as used herein is meant to include naked DNA, chemical formulations containing naked DNA (e.g, a formulation of DNA and cationic compounds (e.g., dextran sulfate)), and naked DNA mixed with an adjuvant such as a viral particle (i.e., the DNA of interest is not contained within the viral particle, but the transforming formulation is composed of both naked DNA and viral particles (e.g., adenovirus particles) (see, e.g., Curiel et al. 1992 Am. J. Respir. Cell Mol. Biol. 6:247-52). Thus “non-viral vector” can include vectors composed of DNA plus viral particles where the viral particles do not contain the DNA of interest within the viral genome.

[0094] In one preferred embodiment, the formulation comprises viral particles which are mixed with the naked DNA construct prior to administration. Preferably, about 10⁸ to 10¹⁰ viral particles (preferably about 1×10⁸ to 5×10¹⁰, more preferably about 3×10¹⁰ particles) are mixed with the naked DNA construct (about 5 μg to 50 μg DNA, more preferably about 8 μg to 25 μg DNA) in a total volume of about 100 μl. Preferably the viral particles are adenovirus particles (Curiel et al., 1992 supra).

[0095] Alternatively or in addition, the DNA of interest can be complexed with polycationic substances such as poly-L-lysine or DEAC-dextran, targeting ligands, and/or DNA binding proteins (e.g, histones). DNA- or RNA-liposome complex formulations comprise a mixture of lipids which bind to genetic material (DNA or RNA) and facilitate delivery of the nucleic acid into the cell. Liposomes which can be used in accordance with the invention include DOPE (dioleyl phosphatidyl ethanol amine), CUDMEDA (N-(5-cholestrum-3-β-ol 3-urethanyl)-N′,N′-dimethylethylene diamine).

[0096] Lipids which can be used in accordance with the invention include, but are not limited to, DOPE (Dioleoyl phosphatidylethanolamine), cholesterol, and CUDMEDA (N-(5-cholestrum-3-ol 3 urethanyl)-N′,N′-dimethylethylenediamine). As an example, DNA can be administered in a solution containing one of the following cationic liposome formulations: Lipofectin™ (LTI/BRL), Transfast™ (Promega Corp), Tfx50™ (Promega Corp), Tfx10™ (Promega Corp), or Tfx20™ (Promega Corp). The concentration of the liposome solutions range from about 2.5% to 15% volume:volume, preferably about 6% to 12% volume:volume. Further exemplary methods and compositions for formulation of nucleic acid (e.g., DNA, including DNA or RNA not contained within a viral particle) for delivery according to the method of the invention are described in U.S. Pat. Nos. 5,892,071; 5,744,625; 5,925,623; 5,527,928; 5,824,812; 5,869,715.

[0097] The DNA of interest can also be administered as a chemical formulation of DNA or RNA coupled to a carrier molecule (e.g., an antibody or a receptor ligand) which facilitates delivery to host cells for the purpose of altering the biological properties of the host cells. By the term “chemical formulations” is meant modifications of nucleic acids to allow coupling of the nucleic acid compounds to a carrier molecule such as a protein or lipid, or derivative thereof. Exemplary protein carrier molecules include antibodies specific to the cells of a targeted secretory gland or receptor ligands, i.e., molecules capable of interacting with receptors associated with a cell of a targeted secretory gland.

[0098] Viral Vectors

[0099] In general, viral vectors used in accordance with the invention are composed of a viral particle derived from a naturally-occurring virus which has been genetically altered to render the virus replication-defective and to express a recombinant gene of interest in accordance with the invention. Once the virus delivers its genetic material to a cell, it does not generate additional infectious virus but does introduce exogenous recombinant genes into the cell, preferably into the genome of the cell.

[0100] Numerous viral vectors are well known in the art, including, for example, retrovirus, adenovirus, adeno-associated virus, herpes simplex virus (HSV), cytomegalovirus (CMV), vaccinia and poliovirus vectors. Retroviral vectors are less preferred since retroviruses require replicating cells and secretory glands are composed of mostly slowly replicating and/or terminally differentiated cells. Adenovirus and AAV are preferred viral vector since this virus efficiently infects slowly replicating and/or terminally differentiated cells. The viral vector may be selected according to its preferential infection of the targeted secretory gland (e.g., where the secretory gland is a salivary gland, the viral vector may be derived from an attenuated (i.e., does not cause significant pathology or morbidity in the infected host, e.g, the virus is nonpathogenic or causes only minor disease symptoms) and/or replication-deficient mumps virus or other attenuated and/or replication-deficient virus which is substantially specific for salivary gland cell).

[0101] Where a replication-deficient virus is used as the viral vector, the production of infective virus particles containing either DNA or RNA corresponding to the DNA of interest can be produced by introducing the viral construct into a recombinant cell line which provides the missing components essential for viral replication. Preferably, transformation of the recombinant cell line with the recombinant viral vector will not result in production of replication-competent viruses, e.g., by homologous recombination of the viral sequences of the recombinant cell line into the introduced viral vector. Methods for production of replication-deficient viral particles containing a nucleic acid of interest are well known in the art and are described in, for example, Rosenfeld et al., Science 252:431-434, 1991 and Rosenfeld et al., Cell 68:143-155, 1992 (adenovirus); U.S. Pat. No. 5,139,941 (adeno-associated virus); U.S. Pat. No. 4,861,719 (retrovirus); and U.S. Pat. No. 5,356,806 (vaccinia virus). Methods and materials for manipulation of the mumps virus genome, characterization of mumps virus genes responsible for viral fusion and viral replication, and the structure and sequence of the mumps viral genome are described in Tanabayashi et al., J. Virol. 67:2928-2931, 1993; Takeuchi et al., Archiv. Virol., 128:177-183, 1993; Tanabayashi et al., Virol. 187:801-804, 1992; Kawano et al., Virol., 179:857-861, 1990; Elango et al., J. Gen. Virol. 69:2893-28900, 1988.

[0102] Conditions or Diseases Amenable to Treatment Using the Method of the Invention

[0103] Various disease conditions are amenable to treatment using the methods of the invention. One skilled in the art can recognize the appropriate protein which should be produced by the invention for treating specific disease conditions. Exemplary diseases which are amenable to treatment using the subject invention, and exemplary, appropriate proteins which can be used in treating these diseases, are shown in Table 2. TABLE 2 Exemplary Disease Conditions Amenable to Treatment Using the Invention Enzyme Deficiency Endotoxic Shock/Sepsis Adenosine deaminase¹ Lipid-binding protein (LBP) Purine nucleotide phosphorylase Galactosidase β-glucuronidase Antioxidants for Cancer Therapy Anemia Superoxide dismutase Erythropoietin Catalase Cancer Growth Factors (for use in wound α-Interferon healing, induction of red blood cell formation, etc.) γ-Interferon Epidermal growth factor α-IL1 G-CSF Phenylalanine ammonia lyase γ-Interferon Arginase Transforming growth factor L-asparaginase Erythropoietin Uricase Thrombopoietin Granulocyte colony stimulating Insulin-like growth factor-1 factor (G-CSF) Monoclonal antibodies Insulin Tissue necrosis factor Human growth hormone Cardiovascular Disease Diabetes Tissue plasminogen activator Insulin Urokinase (native or chimeric) Glucagon α₁-antitrypsin Insulinotrophic hormone Antithrombin-III Other proteases or protease inhibitors Clotting disorders Apolipoproteins (particularly B-48) Clotting factor VIII Circulating Scavenger Receptor APO A1² Obesity and Feeding Gastrointestinal and Pancreatic Ob gene product Deficiencies Cholecystokinin (CCK) Pepsin (for esophageal reflux) Trypsin Chymotrypsin Bone diseases Elastase Calcitonin Carboxypeptidase PTH-like hormone Lactase (for lactose deficiency) Sucrase; Intrinsic Factor (pernicious anemia) Organ-Specific Autoimmune diseases (target of antibody in parentheses) Myasthenia gravis (acetylcholine receptors) Graves' disease (thyroid-stimulating hormone receptor) Thyroiditis (thyroid, peroxidase) Insulin-resistant diabetes with acanthosis nigricans or with ataxia telangiectasia (Insulin receptor) Allergic rhinitis, asthma (Beta₂-adrenergic receptors) Juvenile insulin-dependent diabetes (insulin, GAD65) Pernicious anemia (gastric parietal cells, vitamin B₁₂ binding site of intrinsic factor) Addison's disease (adrenal cells) Idiopathic hypoparathyroidism (parathyroid cells) Spontaneous infertility (sperm) Premature ovarian failure (interstitial cells, corpus luteum cells) Pemphigus (intercellular substance of skin and mucosa) Bullous pemphigoid (basement membrane zone of skin and mucosa) Primary biliary cirrhosis (mitochondria) Autoimmune hemolytic anemia (erythrocytes) Idiopathic thrombocytopenic purpura (platelet) Idiopathic neutropenia (neutrophils) Vitiligo (melanocytes) Osteosclerosis and Meniere's disease (type II collagen) Chronic active hepatitis (nuclei of hepatocytes) Systemic Autoimmune Diseases (defect/organ affected in parentheses) Goodpasture's syndrome (basement membranes) Rheumatoid-arthritis (γ-globulin, EBV-related antigens, collagen types II and III) Sjögren's syndrome (γ-globulin, SS-A (Ro), SS-B (La)) Systemic lupus erythematosus (nuclei, double-stranded DNA, single- stranded DNA, Sm ribonucleoprotein, lymphocytes, erythrocytes, neurons, γ-globulin) Scleroderm (nuclei, Scl-70, SS-A (Ro), SS-B (La), centromere) Polymyositis (nuclei, Jo-1, PL-7, histadyl-tRNA or threonyl-tRNA synthetases, PM-1, Mi-2) Rheumatic fever (myocardium heart valves, choroid plexus)

[0104] Transformation of Secretory Gland Cells

[0105] The DNA of interest-containing vector (i.e., either a viral or non-viral vector (including naked DNA)) is introduced into the secretory gland in vivo via the duct system (i.e., by retrograde intraductal administration, which may be accomplished by perfusion (i.e., continuous injection), or by a single, discontinuous injection). Intraductal administration can also be accomplished by cannulation, which can be accomplished for the pancreas and the liver by, for example, insertion of the cannula through a lumen of the gastrointestinal tract, by insertion of the cannula through an external orifice, insertion of the cannula through the common bile duct. Retrograde ductal administration may be accomplished in the pancreas and liver by endoscopic retrograde chalangio-pancreatography (ECRP). The methods of the invention can involve delivery to both the pancreas, the liver, the salivary gland, or to any combination thereof. Ductal administration provides several advantages. Because the vector is presented to the cells from “outside” the body (from the lumen), the immunological and inflammatory reactions that are commonly observed as a result of the administration of transforming formulations and their adjuvants into blood and interstitial fluid may be avoided.

[0106] Moreover, the cells of secretory glands from a monolayer that encloses the duct system. As a consequence, virtually all of the cells of the glands can be accessed by a single administration into the duct. In this way it is possible to transfect large masses of cells in a relatively simple manner with a single procedure. The DNA of interest can thus also be administered without substantial dilution (it is only diluted by the fluid in the duct system) and without the-need to develop organ specific targeting signals. In contrast, intravenous administration necessarily greatly dilutes the material and requires that it be targeted to the organ of interest in some fashion.

[0107] The amount of DNA to transform a sufficient number of secretory gland cells and provide for expression of therapeutic levels of the protein can be readily determined using an animal model (e.g., a rodent (mouse or rat) or other mammalian animal model) to assess factors such as the efficiency of transformation, the levels of protein expression achieved, the susceptibility of the targeted secretory gland cells to transformation, and the amounts of DNA required to transform secretory gland cells.

[0108] The precise amount of DNA administered will vary greatly according to a number of factors including the susceptibility of the target cells to transformation, the size and weight of the subject, the levels of protein expression desired, and the condition to be treated. For example, the amount of DNA introduced into a secretory gland of a human is generally from about 1 μg to 200 mg, preferably from about 100 μg to 100 mg, more preferably from about 500 μg to 50 mg, most preferably about 10 mg. Specifically, the amount of DNA introduced into the pancreas of a human is, for example, generally from about 1 μg to 100 mg, preferably about 100 μg to 10 mg, more preferably from about 250 μg to 5 mg, still more preferably from about 500 μg to 1.5 mg, most preferably about 1 mg. The amount of DNA introduced into the salivary gland of a human is, for example, generally from about 2.5 μg to 30 mg, more preferably from about 25 μg to 3 mg, still more preferably from about 100 μg to 1 mg, most preferably about 250 μg. The amount of DNA introduced into the liver of a human is, for examples, generally from about 10 μg to 500 mg, more preferably from about 100 μg to 300 mg, still more preferably from about 150 μg to 100 mg, most preferably about 1 mg Generally, the amounts of DNA for human therapy according to the invention can be extrapolated from the amounts of DNA effective for therapy in an animal model. For example, the amount of DNA for therapy in a human is roughly 100 times the amount of DNA effective in therapy in a rat. The amount of DNA necessary to accomplish secretory gland cell transformation will decrease with an increase in the efficiency of the transformation method used.

[0109] The methods of the invention can be used to accomplish delivery of a polypeptide to the bloodstream on either a long term basis (e.g., by repeated administration of the construct) or on a short term basis (e.g., for several hours or a few days). In this regard, the invention takes advantage of the normal turnover of the cells that are transformed by the introduced construct in order to provide a means for controlling dosage of the polypeptide to the bloodstream. In another aspect, where substantially constitutive delivery is desired, then the construct can be introduced into a duct for expression by and delivery from the liver. Furthermore, and without being held to theory, it may be more desirable to introduce the construct for expression by and delivery from the liver where longer term delivery (e.g., weeks to months (e.g., about 3 weeks to about 3 months or more)), while shorter term delivery can be accomplished using the salivary glands or pancreas versus (e.g., hours to days (e.g., about 24, 36, or 48 hours to about 3, 6, or 10 days).

[0110] Intravenous Protein Therapy by Transformation of Salivary Gland, Pancreatic, and Liver Cells

[0111] Secretory glands transformed according to the invention facilitate high levels expression of a DNA of interest, particularly where the DNA of interest is operably linked to a strong eukaryotic promoter (e.g., CMV, MMTV). The expressed protein is then secreted at high levels into the bloodstream. The protein so expressed and secreted is thus useful in treating a mammalian subject having a variety of conditions.

[0112] In a preferred embodiment, the proteins are secreted into the bloodstream at levels sufficient for intravenous protein therapy. For example, the amount of a specific protein normally released into the blood from the pancreas can be substantial, e.g., a specific endogenous protein released into the bloodstream can be as much as 25% of the amount of duct-directed secretion of that protein. This amounts to as much as 1-2 mg of protein/gram of tissue being directed into the blood per hour.

[0113] Bloodstream levels of the therapeutic protein may be enhanced by several different methods. For example, bloodstream levels can be enhanced by increasing the overall level of expression of the desired protein, e.g., by integration of multiple copies of the DNA of interest into the genome of the target cells, by operably linking a strong promoter (e.g., a promoter from CMV) and/or enhancer elements to the DNA of interest in the construct, or by transformation of a greater number of target cells in the subject (e.g., by administration of multiple doses of the transforming material).

[0114] Secretion of the therapeutic protein into the bloodstream can also be enhanced by incorporating leader sequences, amino acid sequence motifs, or other elements that mediate intravenous-directed secretion into the sequence of the therapeutic protein. For example, the DNA of interest can be engineered to contain a secretion signal that directs secretion of the protein primarily into the bloodstream, thereby increasing the amount of the protein produced in the secretory gland that reaches in the bloodstream. Intravenous-directed secretion signals can be identified by, for example, site-directed mutagenesis of DNA encoding a bloodstream-targeted protein (e.g., insulin). The mutants can be screened by expression of the mutated DNA in secretory gland cells and subsequently determining the ratio of, for example, salivary to intravenous expression.

[0115] Alternatively, intravenous-directed secretion signals can be identified by constructing recombinant, chimeric proteins composed of, for example, a putative intravenous secretion signal inserted into a saliva-directed protein. Intravenous secretion signals would then be identified by their ability to re-direct expression of the saliva-directed protein into the bloodstream. Putative intravenous secretion signals and duct system secretion signals can also be identified by comparison of DNA and amino acid sequences of proteins which are preferentially secreted into the bloodstream. Areas of homology or common motifs among the proteins could then be tested as described above.

[0116] Overall secretion from salivary gland and the pancreas can be augmented by hormonal stimulation. For example, where the protein is primarily secreted into the duct system and is secreted at lower levels into the bloodstream, hormonal stimulation enhances intravenous secretion as well as secretion into the duct. Thus, therapeutically effective levels of the protein the bloodstream may be achieved or enhanced by administration of an appropriate, secretory gland specific hormone. For example, secretory gland secretion can be enhanced by administration of a cholinergic agonist such as acetyl-β-methyl choline, or can be augmented or further augmented by control of diet (i.e., eating stimulates pancreatic and salivary gland secretion). Thus, because eating a meal can elicit a secretory response, adjustment of meals (e.g., frequency of meals and/or amounts eaten) can be used as a dosing mechanism for delivery of the desired protein, and can be accomplished without administration of additional protein-encoding DNA.

[0117] Bloodstream-directed secretion can also be regulated at either the level of transcription, translation, or secretion. Transcriptional regulation involves the timing and level of transcription directed from the DNA of interest, while translational regulation involves the production of polypeptides from transcribed RNA. Secretory regulation involves the release of polypeptides from the cell (e.g., from secretory cells in which the polypeptides to be secreted are stored within intracellular vacuoles). Methods for providing transcriptional and/or translational regulation of a DNA of interest are well known in the art (e.g, transcriptional regulation through the use of inducible promoters).

[0118] Secretory regulation can be achieved by, for example, administration of a hormone that elicits a secretory response in the desired secretory gland, or by activity that stimulates production of such hormone(s) (e.g., eating to stimulate pancreatic secretion). Unlike regulation at the level of transcription or translation, which can take many hours to become effective, regulation of secretion occurs within minutes after stimulation. Moreover, endocrine secretion from the pancreas and salivary glands is stimulated by hormones and neurotransmitters that are natural components of the feeding response; thus feeding itself can act as a dosing mechanism.

[0119] The actual number of transformed secretory gland cells required to achieve therapeutic levels of the protein of interest will vary according to several factors including the protein to be expressed, the level of expression of the protein by the transformed cells, the rate of protein secretion, the partitioning of the therapeutic protein between the gastrointestinal tract and the bloodstream, and the condition to be treated. For example, the desired intravenous level of therapeutic protein can be readily calculated by determining the level of the protein present in a normal subject (for treatment of a protein deficiency), or by determining the level of protein required to effect the desired therapeutic result.

[0120] Application of the Method of the Invention to Achieve Euglycemia in a Diabetic Syndrome

[0121] In another preferred embodiment of the invention, pancreatic cells are transformed using insulin-encoding DNA to provide for expression and secretion of insulin into the bloodstream of a mammalian subject. Transformation of pancreatic cells with insulin encoding DNA not only provides for regulated expression of insulin in a mammalian subject, but also provides for maintenance of a euglycemic state (i.e., normal blood glucose levels) in diabetic subjects for extended periods of time (e.g., up to 6 to 7 days post transformation). Thus, not only is the exocrine pancreas secreting insulin to reduce blood sugar, but regulating its secretion so that blood levels are maintained at normal levels, e.g., are regulated. Thus, pancreatic transformation with insulin-encoding DNA can be used in the therapy of individuals having a disease or condition associated with elevated blood glucose levels (e.g., diabetes (e.g., type I or type II diabetes), and hyperglycemia). This aspect of the invention may be applied to regulate levels of other proteins in the bloodstream.

[0122] Assessment of Protein Therapy

[0123] The effects of expression of the protein encoded by the DNA of interest following in vivo transfer of the DNA of interest can be monitored in a variety of ways. Generally, a sample of blood from the subject can be assayed for the presence of the therapeutic protein. Appropriate assays for detecting a protein of interest in blood samples are well known in the art. For example, a sample of blood can be tested for the presence of the polypeptide using an antibody which specifically binds the polypeptide in an ELISA assay. This assay can be performed either qualitatively or quantitatively. The ELISA assay, as well as other immunological assays for detecting a polypeptide in a sample, are described in Antibodies: A Laboratory Manual (1988, Harlow and Lane, eds. Cold Spring Harbor Laboratory, Cold Spring Harbor, N.Y.).

[0124] Alternatively, or in addition, the efficacy of the polypeptide therapy can be assessed by testing a sample of blood for an activity associated with the polypeptide (e.g., an enzymatic activity). Furthermore, the efficacy of the therapy using the methods of the invention can be assessed by monitoring the condition of the mammalian subject for improvement. For example, where the polypeptide is erythropoietin, the subject's blood is examined for hematocrit, iron content or other parameters associated with anemia.

EXAMPLES

[0125] The following examples are put forth so as to provide those of ordinary skill in the art with a complete disclosure and description of how to carry out the invention and is not intended to limit the scope of what the inventors regard as their invention. Efforts have been made to ensure accuracy with respect to numbers used (e.g., amounts, temperatures, etc.), but some experimental error and deviation should be accounted for. Unless indicated otherwise, parts are parts by weight, molecular weight is weight average molecular weight, temperature is in degrees Centigrade, and pressure is at or near atmospheric.

Example 1 In vivo Gene Transfer to Salivary Glands by Administration of Naked DNA Encoding Insulin

[0126] Four adult rats weighing approximately 300 g each were anesthetized with an intraperitoneal injection of sodium pentobarbital. An incision was made parallel to the line of the mandible and both parotid glands exposed by dissection. Two rats received a total of 100 μl of 0.5 μg/μl pBAT14.hIns plasmid which contains cDNA encoding human insulin (FIG. 1), while the remaining two rats received 100 μl 0.9% saline (sham animals). The test and control samples were administered by multi-site subcapsular injection to each parotid gland of each animal. No significant leakage of material or bleeding occurred. The wound was closed after administration. After 3 hours, the animals were awake, drinking water, and appearing normal.

[0127] Approximately 24 hours after cDNA injection, the animals were again anesthetized and a tracheostomy performed. A control blood sample was drawn from the femoral vein of each animal. The cholinergic agonist acetyl-p-methyl choline (McH) was injected into each subcutaneously at 0.8 mg/kg body weight into each animal. The salivary glands appeared normal and showed no signs of inflammation. Twenty minutes after McH injection, saliva and blood samples were collected from each animal. The blood samples were collected from the inferior vena cava and by heart puncture. Serum was separated from the blood of all samples after clotting, and kept at −20° C. prior to assay. In addition, blood was collected from 10 normal rats, and serum prepared to determine the blood level of insulin in untreated rats.

[0128] The results of this experiment are shown in Table 3. The level of insulin in the blood of transfected animals and in blood of untransfected animals was essentially the same. Administration of McH induced an increase in serum insulin levels in both the control and transfected animals. The concentration of insulin was higher after McH stimulation in the two transfected animals than in the McH-stimulated control animals. TABLE 3 Treatment Insulin (μU/ml) Normal (untreated)  2.6 cDNA 1 −McH  1.4 +McH 10.0 cDNA 2 −McH  2.5 +McH 11.6 Control 1 −McH  2.0 +McH  5.6 Control 2 −McH  2.0 +McH  9.2

Example 2 In vivo Gene Transfer to Salivary Glands by Administration of an Increased Dosage Naked DNA Encoding Insulin

[0129] In a second experiment, four adult rats weighing approximately 300 g each were anesthetized with an intraperitoneal injection of sodium pentobarbital. Two rats received a total of 100 μl of 1-1.2 μg/μl pBAT14.hIns plasmid containing cDNA encoding human insulin, while the remaining two rats received 100 μl 0.9% saline (control animals). The test and control samples were administered by multi-site subcapsular injection to each parotid gland of each animal as described above in Example 1, and the wound closed after administration.

[0130] Approximately 24 hours after injection, the animals were again anesthetized, blood samples drawn from each animal, and the cholinergic agonist McH administered at 0.8 mg/kg body weight by subcutaneous injection. Twenty minutes after McH injection, blood samples were drawn from the inferior vena cava and by heart puncture of each animal. Serum was separated from the blood of all samples after clotting, and kept at −20° C. prior to assay for insulin. The parotid glands of all animals looked normal and showed no signs of inflammation.

[0131] As shown in Table 4, the levels of insulin in the blood of the transfected animals was substantially higher than in the previous experiment, suggesting that the increased dosage of cDNA resulted in increased insulin production. Insulin levels in the transfected animals were elevated by McH stimulation. Moreover, the animals transfected with 100 μg-120 μg cDNA had about 50% greater insulin levels after McH stimulation than the animals transfected with 50 μg cDNA described above. TABLE 4 Treatment Insulin (μU/ml) cDNA 3 −McH  6.4 +McH 15.2 cDNA 4 −McH  7.2 +McH 15.2

Example 3 Effects of Isoprenaline Stimulation on Expression of Insulin Following in vivo Transformation of Salivary Glands

[0132] Two transfected rats and two control rats were treated using the same protocol, vector, and dose as in Example 2. Approximately 24 hours after injection, the animals were again anesthetized, blood samples drawn from each animal, and the adrenergic agonist isoprenaline (IsO) was administered at 0.1 μg/kg body weight by subcutaneous injection. Twenty minutes after Iso injection, blood samples were drawn from the inferior vena cava and by heart puncture of each animal. Serum was separated from the blood of all samples after clotting, and kept at −20° C. prior to assay for insulin.

[0133] As shown in Table 5, the blood insulin levels in the transfected animals was substantially elevated relative to control values. Injection of Iso had no effect upon blood insulin levels. TABLE 5 Treatment Insulin (μU/ml) cDNA 5 −IsO 8.5 +IsO 8.0 cDNA 6 −IsO 6.4 +IsO 8.0

Example 4 Effects of Streptozotocin on Insulin Levels in Rats Following in vivo Transfer of cDNA Encoding Insulin to Salivary Glands

[0134] Streptozotocin, which induces diabetes mellitus in rats, was administered to three adults rats weighing approximately 220-230 g at 70 mg/kg body weight by intraperitoneal injection. The animals were anesthetized by intraperitoneal injection of sodium pentobarbital. Two of the animals received a 50 μl volume of 2 μg/μl pBAT14.hIns plasmid which contains cDNA encoding human insulin. The remaining rat received 100 μl 0.9% saline (control animal). The test and control samples were administered by multi-site subcapsular injection to each parotid gland of each animal as described in Example 1.

[0135] Approximately 48 hours after cDNA or saline injection, the animals were again anesthetized and a tracheostomy performed. A control blood sample was drawn from the femoral vein of each animal. McH was administered at 0.8 mg/kg body weight by subcutaneous injection. Twenty minutes after McH injection, saliva and blood samples were collected from each animal. The blood samples were collected from the inferior ven cava and by heart puncture. Serum was separated from the blood of all samples after clotting, and kept at −20° C. prior to assay. In addition, the salivary glands and a portion of the pancreas were removed and homogenized in 50 mM phosphate buffer (pH 8.0) 1:10 w/v. The homogenates were spun at 50,000×g for 1 h and the supernatant stored at −20° C. A small portion of parotid salivary glands were fixed in 10% buffered formalin and saved for histologic examination. The parotid glands showed no observable signs of inflammation as a result of cDNA injection.

[0136] As shown in Table 6, streptozotocin administration decreased the blood levels of insulin in the transfected animals. Stimulation with McH was effective in increasing serum insulin levels in one of the two transfected animals, but not in the control animal. TABLE 6 Treatment Insulin (μU/ml) Glucose (mg/dl) cDNA −McH 0.5 268 +McH 8.8 385 cDNA −McH 1.6 321 +McH 1.0 413 Control −McH 5.2 230 +McH 4.8 335

Example 5 Summary of Results of in vivo Gene Transfer to Salivary Glands by Percutaneous Administration of Naked DNA Encoding Insulin

[0137] Nine adult rats were anesthetized with an intraperitoneal injection of sodium pentobarbital. Six rats were injected percutaneously with DNA encoding insulin. Two rats received a 100 μl volume of 0.5 μg/μl pBAT14.hIns plasmid which contains cDNA encoding human insulin (low dose animals), while the four other transfected rats received a 100 μl volume of 1.0 μg/μl pBAT14.hIns (high dose animals). The remaining three rats received 100 μl 0.9% saline (sham animal).

[0138] Approximately 24 hours after injection, the animals were again anesthetized. Control blood samples were drawn from the femoral vein of each animal. Two of the control animals, two of the low dose animals, and two of the high dose animals received a subcutaneous injection of 0.8 mg/kg body weight McH. Two of the high dose transfected animals received a subcutaneous injection of the adrenergic agonist IsO at 0.1 μg/kg body weight. Twenty minutes after McH or Iso injection, saliva and blood samples were collected from each animal. The blood samples were collected from the inferior ven cava and by heart puncture. Serum was separated from the blood of all samples after clotting, and kept at −20° C. prior to assay.

[0139] The results of this experiment are shown in Table 7. The serum insulin levels were highest in the high dose transfected animal group. The serum insulin levels of the low dose transfected group and the control group were similar. After stimulation with McH, serum insulin levels were again markedly higher in the high dose transfected group than in either the low dose transfected or the control groups. Serum insulin levels after McH stimulation were higher in the low dose transfected group than in the control group. Iso injection of high dose transfected rats had no significant effect upon serum insulin levels as compared to serum insulin levels in the absence of agonist. These data show that high dose cDNA increase both unstimulated (-McH) and McH-stimulated insulin responses. TABLE 7 Average values for the effect percutaneous administration of human insulin cDNA to parotid gland on serum insulin Treatment Insulin (μU/ml) Control  2.5 (12) Low dose cDNA (0.5 μg/μl)  2.0 (2) High dose cDNA (1.0 μg/μl)  7.4 (6) With cholinergic stimulation (McH) Control  7.6 (2) Low dose cDNA (0.5 μg/μl) 13.0 (2) High dose cDNA (1.0 μg/μl) 15.2 (2)

Example 6 In vivo Gene Transfer of DNA Encoding Human Growth Hormone by Retrograde Intraductal Administration of DNA

[0140] A DNA fragment encoding human growth hormone (hGH) is operably linked to the LTR of Rous sarcoma virus, which serves as a promoter, and the SV40 type T antigen, which serves as a nuclear localization signal. This promoter-localization signal-hGH DNA cassette is then inserted into the bacterial plasmid pBR322. Escherichia coli is then transformed with the plasmid using conventional transformation procedures. E. coli containing the plasmid are selected by virtue of the tetracycline or ampicillin resistance encoded by pBR322, and the transformed bacterial cells propagated in culture. Plasmid DNA is then isolated from the transformed bacterial cell culture and the DNA purified by cesium gradient.

[0141] Approximately 10 mg to 20 mg of the purified plasmid DNA containing hGH DNA is administered into the salivary gland of a human patient by retrograde administration via a salivary gland duct. Expression and intravenous secretion of the protein is assessed using the method described above.

Example 7 In Vivo Transformation of Salivary Glands by Retrograde Intraductal Administration of DNA Encoding Human Growth Hormone

[0142] Four constructs for expression of human growth hormone (hGH) were prepared using techniques well known in the art (see, for example, Sambrook et al. ibid). The first construct, pFGH, contains the genomic hGH DNA sequence inserted in the commercially available vector pBLUESCRIPT SK+™ (Stratagene, LaJolla Calif.) (FIG. 2). Because the hGH coding sequence is not linked to a promoter, this vector provides for no or only low-level hGH expression. Thus, the pFGH construct serves as a negative control for hGH expression in the pancreas. The second construct, pFGH.CMV, was constructed by operably inserting the promoter from the immediate early gene of human CMV upstream of the genomic hGH sequence of the pFGH vector (FIG. 3). The third construct, pFGH.chymo, was constructed by operably inserting the rat chymotrypsin B gene promoter upstream of the genomic hGH sequence of the pFGH vector (FIG. 4). The fourth construct, pFGH.RSV, was constructed by operably inserting the promoter from the long terminal repeat (LTR) of RSV upstream of the genomic hGH sequence of the pFGH vector.

[0143] Twelve adult rats weighing approximately 300 g each were anesthetized with an intraperitoneal of sodium pentobarbital. A total volume of 50 μl containing 4 μg of the pFGH.CMV plasmid, which contains cDNA encoding human growth hormone (hGH), was introduced into each submandibular gland of 8 rats by retrograde ductal administration via the ducts leading from the oral mucosa to the salivary gland. Briefly, both the left and right Wharton's duct were cannulated intraorally with polyethylene (PE) 10 tubing, and the DNA introduced into the duct system of each gland in a retrograde fashion (4 μg/50 μl of PBS). The material was kept in place for two minutes before normal flow was reestablished.

[0144] For three of these animals the DNA was mixed in a 6% solution of the cationic lipid Lipofectin (labeled “liposomes”) from Life Technologies (Gaithersburg, Md.). For four of these animals, the DNA was mixed with a 1:50 dilution of replication-defective human adenovirus (Ad5-di 342) supernatant. Control rats (4 rats) received 50 μl 0.9% saline (control) without plasmid. No significant leakage of material or bleeding occurred. After 3 hours, the animals were awake, drinking water, and appearing normal.

[0145] Approximately 48 hours after cDNA administration, the animals were sacrificed. The right and left submandibular glands were removed and were homogenized in cold 0.2 M (pH 8.0) sodium phosphate buffer (1:10 w/v) containing the protease inhibitors aprotinin, leupeptin, pepstatin, and PEFABLOC SC™. Homogenization was completed by shearing after 10 passes with a motorized pestle at approximately 4000 rpm in a glass homogenizer. The homogenates were centrifuged at 1000 g for 15 min, and the supernatant collected and stored at −80° C. until analysis. The levels of hGH in the protein samples were measured using the hGH radioimmune assay (Nichols Institute). Each assay was performed in duplicate and compared to a set of control samples.

[0146] Each of the submandibular glands into which the pFGH.CMV vector was introduced expressed hGH in the salivary gland tissue; hGH expression was undetectable in the control rats' salivary glands (FIG. 5).

Example 8 In Vivo Transformation of Salivary Glands by Retrograde Intraductal Administration of hGH-Encoding DNA and Regulation of hGH Secretion

[0147] Three adult rats weighing approximately 300 g each were anesthetized with an intraperitoneal injection of sodium pentobarbital. A control blood sample (prior to DNA) was drawn from the femoral vein of each animal. A total of 4 μg of the hGH-encoding plasmid pFGH.CMV in 50 μl, was introduced into each submandibular gland of each rat by retrograde ductal administration via the ducts leading from the oral mucosa to the salivary gland as described above. No significant leakage of material or bleeding occurred. After 3 hours, the animals were awake, drinking water, and appearing normal.

[0148] Forty-eight hours after cDNA administration, the animals were again anesthetized and a control blood sample was drawn from the femoral vein of each animal (unstimulated serum level). The cholinergic agonist acetyl-β-methyl choline (McH) was injected subcutaneously at 0.8 mg/kg body weight into each animal. Blood samples were collected from the femoral vein of each animal at 10 min, 20 min, 40 min, and 50 min after McH injection. Serum was separated from the blood of all samples after clotting, and kept at −20° C. prior to assay.

[0149] As shown in FIG. 6 (one representative animal), secretion of hGH into the bloodstream was dramatically increased in response to administration of McH, peaking at 40 min. Thus, these data demonstrate that introduction of hGH-encoding DNA into the salivary gland results in bloodstream-directed secretion of hGH and regulation by cholinergic stimulation. Moreover, regulation is at the level of secretion, not transcription, since transcriptional regulation would not result in increased hGH bloodstream levels in such a short period.

Example 9 Human Growth Hormone (hGH) Expression in Rat Salivary Gland

[0150] Four micrograms of the pFGH.CMV construct, premixed with either Lipofectin or adenovirus, was introduced into each submandibular gland via retrograde ductal administration (via Wharton's duct) as described above. Two days later, each gland was harvested and hGH content was measured

[0151] As shown in FIG. 7, tissue levels of hGH averaged about 50 ng/g tissue wet weight. Plasma hGH levels were in the 20-40 pg/ml range. As in the pancreas, the addition of adenovirus increased tissue hGH levels, in this case to 100 ng/g (FIG. 21).

Example 10 In vivo Gene Transfer of DNA Encoding Human Growth Hormone by Retrograde Intraductal Administration of DNA into the Pancreas

[0152] Each of the vectors of FIGS. 2-4 were used to transfect the pancreas of approximately 300 g adult rats (pFGH+lipofectin, 4 rats; pFGH.chymo+lipofectin, 4 rats; pFGH.RSV+lipofectin, 4 rats; pFGH.CMV+lipofectin, 10 rats; pFGH.CMV without lipofectin, 7 rats; negative control (no DNA, no lipofectin), 3 rats). Pancreatic transfection was accomplished by first anesthetizing the rats and performing a laparotomy to expose the duodenum. The pancreas and the associated common bile duct were identified, and the common bile duct was cannulated either extraduodenally or through the papilla of Vater. The hepatic duct was occluded, and 100 μl of phosphate-buffered saline (PBS) containing one of the four vectors, or 100 μl of PBS alone as a negative control, were slowly introduced into the pancreatic duct in a retrograde direction. The vector-containing solutions were composed of 8 μg DNA per 100 μl in PBS, either with or without 6% lipofectin, a cationic lipid used to increase transfection efficiency. The solution was left in place for 5 min before secretory flow was allowed to resume and hepatic duct blockage removed. The catheter was left in place and inserted into the duodenum through a small hole to ensure adequate biliary and pancreatic flow post-operatively. The abdomen was then closed with sutures. The animals recovered fully and rapidly from the surgery without obvious side effects. This transfection method provides direct access of the vector to over 90% of the pancreatic gland cells.

[0153] At 48 hr after surgery, a blood sample was obtained to measure serum hGH levels, and the rats were sacrificed. At autopsy, the pancreas of both control and test rats appeared normal, and exhibited no gross or microscopic pathology.

[0154] The pancreas was dissected free from the mesenteric surface and was homogenized in cold 0.2 M (pH 8.0) sodium phosphate buffer (1:10 w/v) containing protease inhibitors aprotinin, leupeptin, pepstatin, and PEFABLOC SC™. Homogenization was completed by shearing after 10 passes with a motorized pestle at approximately 4000 rpm in a glass homogenizer. The homogenate was then centrifuged at 1000 g for 15 min. The supernatant was collected and stored at −80° C. until analysis. The levels of hGH in the serum and pancreatic protein samples were measured using the hGH radioimmune assay (Nichols Institute). Each assay was performed in duplicate and compared to a set of control samples.

[0155] Rats that received the pFGH.CMV vector expressed higher levels of hGH in the pancreatic tissue (FIG. 8), compared to background levels of pancreatic hGH expression in rats that received either no DNA (PBS alone) or the pFGH vector (hGH DNA with no promoter). The addition of lipofectin modestly increased hGH expression in rats that received the pFGH.CMV construct. In addition, rats that received the pFGH.CMV vector secreted hGH in the serum at levels increased relative to hGH secretion levels in rats treated with either control samples (no DNA or pFGH, or with samples containing hGH DNA linked to either the chymotrypsin B or RSV promoters (FIG. 9). In FIG. 10, all data from the above experiments (including all controls and vectors) are analyzed by plotting the hGH serum levels against the hGH tissue levels. This graph shows that higher tissue levels result in higher levels of secretion into the blood. Thus, retrograde intraductal pancreatic administration of the pFGH.CMV vector successfully transfected pancreatic cells to provide both hGH pancreatic tissue expression and hGH secretion into the bloodstream.

Example 11 In Vivo Transformation of Pancreatic Cells by Retrograde Intraductal Administration of hGH-Encoding DNA and Regulation of hGH Secretion

[0156] Eight rats were anesthetized and control blood samples (no DNA) were collected from the femoral vein of each animal. Pancreatic transfection was accomplished by exposing the duodenum by laparotomy and identifying the pancreas and the associated common bile duct. The common bile duct was cannulated either extraduodenally or through the papilla of Vater, and the hepatic duct was occluded. A 1:50 dilution of replication-defective human adenovirus (Ad5-di 342) supernatant in 100 μl of phosphate-buffered saline (PBS) containing 8 μg of the hGH-encoding plasmid pFGH.CMV (FIG. 3) was slowly infused into the pancreatic duct in a retrograde direction. The solution was left in place for approximately 5 min before secretory flow was allowed to resume and the hepatic duct blockage removed. The catheter was left in place and inserted into the duodenum through a small hole to ensure adequate biliary and pancreatic flow post-operatively. The abdomen was then closed with sutures. The animals recovered fully and rapidly from the surgery without obvious side effects.

[0157] At 48 hr after surgery, a blood sample was obtained to measure serum hGH levels (unstimulated serum levels). The cholinergic agonist McH was injected subcutaneously into each rat at 0.8 mg/kg body weight. Blood samples were collected from the inferior vena cava of each animal at 15 min intervals following McH injection. Serum was separated from the blood of all samples after clotting, and kept at −20° C. prior to assay.

[0158] As shown in FIG. 11 (one representative animal) plasma levels of hGH increased markedly following McH injection, demonstrating that secretion of hGH expressed by transformed pancreatic cells is regulated by agonist stimulation. Moreover, bloodstream-directed secretion of hGH from the transformed pancreatic cells occurred at relevant, physiological levels useful in therapeutic administration (i.e., at the ng/ml level).

Example 12 Treatment of Diabetes Mellitus Over a Three Day Period by In Vivo Transformation of Pancreatic Cells by Retrograde Intraductal administration with Insulin-Encoding DNA

[0159] Streptozotocin, which induces diabetes mellitus in rats, was administered to 8 male Sprague-Dawley rats (260-280 g) after overnight fasting by intraperitoneal injection in 1 mM citrate buffer (pH 4.5) (Sigma) at 65 mg/kg of body weight. One hour later, animals were anesthetized with Nembutal and the body cavity opened to expose the gastrointestinal tract. Each animal was given the appropriate DNA construct directly by retrograde administration in the pancreatic duct in a 100 μl volume containing 8 μg DNA plus adenovirus (Ad5-di 342)(3×10¹⁰ viral particles) as described above. Test animals (4 rats) received the human insulin-encoding construct pBat16.hInsG1.M2. The pBAT16.hInsG1.M2 construct (FIG. 12) encodes an insulin gene containing a site-directed mutation of the second protease site to create a furin recognition site; this construct provides for enhanced expression of processed insulin in non-neuroendocrine cells. In addition, the human β-globin first intron replaces the first insulin gene intron which is inefficiently spliced. Control animals (4 rats) received the control construct CMV-GFP, which contains a green fluorescent protein (GFP)-encoding sequence operably linked to a CMV promoter. The animals recovered fully and rapidly from the surgery without obvious side effects. Body weight and blood glucose were monitored daily for three days post-administration. Blood glucose was measured by the glucose oxidase method (Lifescan, Milpitas, Calif.).

[0160] As shown in FIG. 13, treatment of the streptozotocin-induced diabetic rats with the insulin-encoding construct resulted in maintenance of almost complete euglycemia for 3 days. In contrast, control animals that received the GFP-encoding construct remained hyperglycemic throughout the test period. The data show that introduction of insulin-encoding DNA into the pancreas results in pancreatic cell transformation, as well as secretion of insulin by the transformed pancreatic cells at levels sufficient to overcome diabetes in an animal model. Moreover, these results show that the method of the invention provides regulated and relatively normal blood glucose levels. Surprising, the exocrine pancreas regulates the release of insulin such that blood sugar levels are maintained at regulated levels (normally the endocrine pancreas is responsible for regulation of bloodstream-directed secretion).

Example 13 Treatment of Diabetes Mellitus Over a Six Day Period by In Vivo Transformation of Pancreatic Cells by Retrograde Intraductal Administration with Insulin-Encoding DNA

[0161] Streptozotocin was administered to 14 rats at 70 mg/kg body weight by intraperitoneal injection to induce diabetes mellitus. The animals were then anesthetized by intraperitoneal injection of sodium pentobarbital. Two rats did not receive streptozotocin and served as one negative control. Insulin-encoding DNA in the pBAT16.hInsG1.M2 construct (FIG. 12) was administered to 8 of the streptozotocin-injected rats by retrograde ductal administration as described above. Six streptozotocin-treated rats received either 100 μl of saline without DNA (2 animals) or a control DNA without the human insulin gene (4 animals) by pancreatic retrograde ductal administration as additional negative controls. The animals recovered fully and rapidly from the surgery without obvious side effects. Blood samples were collected from the femoral vein of each animal at 24 hr intervals for 6 days. Human insulin was measured using a double antibody radioimmunoassay (Linco Laboratories, Saint Louis, Mo.).

[0162] As shown in (FIG. 14), blood glucose levels were significantly decreased in the diabetic rats that received the insulin-encoding DNA (+Strep, +DNA) relative to diabetic the rats that received no DNA (+Strep, No DNA). Furthermore, these decreased blood glucose levels were observed throughout the entire 6 day course of the experiment. Thus, these data show that introduction of insulin-encoding DNA into the pancreas results in persistent expression of insulin, and that the insulin expressed by the transformed pancreatic cells is secreted into the bloodstream and can function in regulation of blood glucose at levels sufficient to overcome diabetes in an animal model. As shown in FIG. 14, elevated insulin levels for such an extended period additionally demonstrate prolonged expression from the DNA introduced into the pancreatic cells.

Example 14 In Vivo Transformation of Pancreatic Cells by Retrograde Intraductal Administration of Green Fluorescent Protein-Encoding DNA and Expression in Pancreatic Cells

[0163] To identify the pancreatic cells that expressed the recombinant protein, DNA encoding green fluorescent protein (GFP) was used to transform pancreatic cells according to the methods of the invention. EGFP cDNA from plasmid pEGFP.C2 (Clontech) was inserted into pFOX. The EGFP sequence was modified to contain an SV40 nuclear localization signal, in-frame at the 3′ end. This addition allowed for partial nuclear localization and facilitated immunohistochemical detection. The CMV immediate early promoter was positioned upstream of the first intron of human β-globin to create the expression vector pFOX.EGFP.N2.CMV.

[0164] After fasting overnight, Male Sprague-Dawley rats (260-280 g) were anesthetized and the body cavity opened to expose the gastrointestinal tract. The green fluorescent protein (GFP)-encoding construct pFOX.EGFP.N2.CMV was administered to each animal by retrograde administration in the pancreatic duct in a 100 μL volume containing 8 μg DNA premixed with adenovirus (3×10¹⁰ viral particles) as described above. The animals recovered fully and rapidly from the surgery without obvious side effects.

[0165] Seventy-two hours post-treatment, the animals were sacrificed, and pancreases were removed and weighed (wet weight). Samples of each pancreas were fixed in 5% buffered formalin for 24-48 hours at room temperature. Fixed tissues were dehydrated and imbedded in paraffin, and 5 μm sections were processed for immunohistochemistry using standard techniques. Endogenous peroxidase was quenched in 0.7% H₂O₂/MeOH, and antigen retrieval was performed using Citra solution (Biogenex, San Ramon, Calif.) according to the manufacturers' instructions. Sections were preincubated for 30 minutes in 5% goat serum/phosphate-buffered saline (PBS), and then incubated overnight at 4° C. with primary antisera diluted in 5% goat serum/PBS.

[0166] The primary antisera were selected from either anti-GFP antisera (1:1500; Clontech, Palo Alto, Calif.), anti-insulin antisera (1:500; Dako, Carpenteria, Calif.), or non-specific rabbit sera (1:1500). The following day all sections were incubated with biotinylated goat anti-rabbit antiserum (5 μg/ml; Vector, Burlingame, Calif.) for 30 minutes at room temperature, and then incubated with streptavidin-aminohexanol-biotin horseradish peroxidase (HRP) complex (Vectastain-Elite, Vector). Protein was visualized by reaction with the peroxidase substrate 3,3-diamino-benzidine tetrahydrochloride (DAB; Sigma). The color reaction was followed by a brief counter stain in 1% methyl green (Sigma) prior to mounting. Negative controls included staining of sections from pancreas with no CMV-GFP administration, and omission of primary antiserum.

[0167] Staining for GFP was observed in the pancreas of animals treated with GFP DNA, but not in control animals. GFP expression was restricted to exocrine cells; there was no staining in either ductal or islet cells. Moreover, expression was observed in 0.1-1.0% of exocrine cells. Endogenous insulin was detected in adjacent sections; but GFP expression did not co-localize with insulin expression, suggesting that the pancreatic cells primarily transformed are exocrine, not endocrine cells. Under the conditions studied there was no histological indication of inflammatory infiltration as a consequence of ductal administration of the vector.

[0168] These data show that introduction of the DNA construct results in successful transformation of pancreatic cells, despite the introduction of the construct against the flow of pancreatic juice and the high concentrations of DNase in the pancreatic juice. Moreover, these data, combined with the data above showing that transformation of the pancreas results in bloodstream-directed secretion of the encoded protein, and suggest that transformation of exocrine pancreatic cells results in bloodstream-directed secretion of the protein encoded by the introduced construct. Furthermore, because insulin staining and GFP staining did not co-localize, introduction of the GFP-encoding construct resulted in transformation of exocrine tissue, which is normally associated with protein secretion into the gastrointestinal tract, rather than endocrine tissue, which is normally associated with bloodstream-directed secretion. Despite this, bloodstream-directed secretion was still obtained at physiologically relevant levels sufficient to treat diabetes mellitus in an animal model as evidenced in the examples above.

Example 15 In Vivo Transformation of Pancreatic Cells with hGH-Encoding DNA and Expression in Rat Exocrine Pancreas and Plasma

[0169] Following overnight fasting and anesthesia with pentobarbital, the abdominal cavity of the rats was opened and the pancreatic duct cannulated external to the duodenum with PE 10 tubing as described above. Eight to twenty-five micrograms of each of pFGH (promoter less construct), pFGH.chymo (construct with the chymotrypsin promoter), pFGH.RSV (construct with the RSV promoter), and pFGH.CMV (construct with the CMV promoter) was administered in a total volume of 100 μl of PBS into the pancreas via the pancreatic duct as described above. Immediately prior to administration construct samples were optionally premixed with either Lipofectin (6-12% vol:vol) or adenovirus (3×10¹⁰ viral particles). The material was kept in the duct for 5 min prior to establishing normal flow. The abdomen was the closed and the animals allowed to recover.

[0170] Forty-eight hours later the pancreas was harvested, plasma obtained, and human growth hormone measured. The animals were anesthetized, blood samples taken (either from the femoral vein or inferior vena cava), and the transfected tissue removed. The tissue was homogenized in PBS containing 5 mM Na2HPO₄ (pH 7.8) at a tissue to fluid ratio of 1:10 using a motorized mortar and pestle. Large particulate material in the homogenate was removed by sedimentation at 10,000×g for 30 minutes, and the supernatant assayed for the protein of interest. The results are shown in FIGS. 15-18. All data shown are the mean ± the SEM.

[0171] The effects of the various promoters upon tissue expression of hGH are shown in FIGS. 15 and 16, respectively. In these experiments, the constructs were mixed with lipofection prior to administration. Of the promoters tested, the CMV promoter was by far the most effective, and produced high levels of hGH in tissue (in the range of 150 ng/g tissue wet weight) when compared to either promoter less controls, or plasmids containing RSV and chymotrypsin promoters (FIG. 15). The cationic lipid adjuvant Lipofectin increased expression by about 50%, and pre-mixing the plasmid with adenovirus enhanced tissue expression five fold (FIG. 16). Expression of hGH at 24, 48 or 72 hours after administration was similar under all conditions studied.

[0172] As shown in FIGS. 17 and 18, hGH was secreted into plasma. Plasmids containing the CMV promoter increased circulating levels of hGH five times above background (FIG. 17). With plasmid alone, plasma hGH concentrations in the range of 60 to 80 pg/ml were routinely observed. Premixing the plasmids with adjuvants also increased circulating hGH levels (FIG. 18). Lipofectin increased plasma levels by an additional 50%, and adenovirus by 75%, when compared to plasmid alone.

Example 16 Human Insulin Expression and Secretion in Diabetic Rat Pancreas

[0173] In an attempt to treat a disease state, diabetes mellitus, we expressed human insulin in the exocrine pancreas. Fasted experimental and control animals received intra-peritoneal streptozotocin (Sigma; 65 mg/kg body weight, in 1 mM citrate buffer, pH 4.5) on day zero one hour prior to administration of the insulin-encoding construct. The experimental animals subsequently received 8 μg of the insulin plasmid (pBAT16.hInsG1.M2) premixed with adenovirus and introduced into the pancreatic duct, also on day zero. The pBAT16.hInsG1.M2 construct contains the human insulin cDNA linked to a CMV immediate early promoter, which is positioned upstream of the first intron of human P-globin. The human insulin cDNA was mutated to convert the second protease site, between peptides C and A, to a furin recognition site. This allows for correct proteolytic processing of mature insulin in non-endocrine cells.

[0174] Plasma insulin and glucose levels were determined for up to six days. Plasma glucose levels in diabetic rats (n=3), and diabetic rats treated with the pBAT16.hInsG1.M2 plasmid (n=3), measured over a three day period, are shown in FIG. 19. Plasma insulin levels in diabetic rats (n=3), and diabetic rats treated with the pBAT16.hInsG1.M2 plasmid (n=3), measured over a three day period, are shown in FIG. 20. Plasma glucose levels in individual diabetic (n=3) and pBAT16.hInsG1.M2 plasmid-treated diabetic rats (n=3), measured over a six day period, are shown in FIG. 21.

[0175] As a consequence of streptozotocin administration, blood glucose levels rose from the normal level of 100 mg/dl to 300-400 mg/dl within 24 hours and remained elevated for the duration of the study (FIG. 19). Treatment with the human insulin plasmid reduced blood glucose levels in diabetic rats to the normal range (FIGS. 19 and 21), and concentrations of insulin remained near pre-treatment values (FIG. 20). Blood glucose levels were euglycemic for the duration of the study (6 days; FIG. 21). Animals transfected with a control plasmid remained diabetic (data not shown). These data show that regulation of insulin secretion in response to feeding was effective.

Example 17 In Vivo Transformation of Liver Cells by Retrograde Intraductal Administration of hGH-Encoding DNA and Bloodstream-Directed hGH Secretion

[0176] Four rats were anesthetized and control blood samples (no DNA) were collected from the femoral vein of each animal. Expression of the construct in liver cells was accomplished by exposing the duodenum by laparotomy and identifying the liver and the associated common bile duct. The common bile duct was cannulated either extraduodenally or through the papilla of Vater. The tubing was advanced to the bifurcation of the hepatic duct in order to prevent introduced material from entering the distally located pancreatic drainage. A 1:50 dilution of replication-defective human adenovirus supernatant in 100 μl of phosphate-buffered saline (PBS) containing 8 μg of the hGH-encoding plasmid pFGH.CMV or 100 μl of PBS alone (no DNA) were slowly infused into the hepatic duct in a retrograde direction. The solution was left in place for approximately 2 min to 5 min before secretory flow was allowed to resume and the pancreatic duct blockage removed. The catheter was left in place and inserted into the duodenum through a small hole to ensure adequate biliary and pancreatic flow post-operatively. The abdomen was then closed with sutures. The animals recovered fully and rapidly from the surgery without obvious side effects.

[0177] Plasma hGH levels were measured 2 days after treatment; the results are shown in FIG. 22. Each data point in FIG. 22 represents the mean±standard error of the mean (SEM) for three animals. These data demonstrate that liver cells were transformed with the hGH-encoding DNA. Furthermore, hGH was secreted by the transformed liver cells into the bloodstream at physiologically relevant levels.

Example 18 Stimulation of Human Growth Hormone (hGH) Secretion

[0178] Even when exocrine secretory cells store large amounts of protein, such as after a period of fasting, they secrete these proteins at a low rate under unstimulated conditions (i.e. basal or constitutive secretion). Greater rates are achieved when exogenous stimulants (e.g., hormonal stimulants and/or stimulation associated with eating) are applied. To determine whether secretion of the engineered protein would be enhanced during feeding, pancreatic secretion was stimulated with a secretory stimulant. For these experiments we used animals in which both pancreas and liver were transfected. Eight micrograms of the pFGH.CMV construct were introduced into ducts of both the pancreas and liver of four rats as described above. A blood sample was taken prior to administration as a control. Two days after transfection, a second control blood sample was taken and the rats were treated with the cholinergic agonist, acetyl-β-methylcholine (McH) (0.8 mg/kg body weight).

[0179] As shown in FIG. 23, hGH secretion was increased three fold within 30 minutes of stimulation, with plasma levels approaching 1.0 ng/ml. Similar enhancement of hGH secretion was observed when either the pancreas was studied alone, or when the salivary glands were studied alone. These data show that hGH secretion is enhanced by stimulation with a cholinergic agonist. Thus secretion of hGH is regulated in a manner similar to secretion of endogenous proteins.

[0180] Although the concentration of hGH in plasma was correlated to the level of hormone in the pancreas (r=0.55, p<0.01, n=41), at high tissue levels, plasma concentration was not linearly proportional to tissue content. For example, addition of adenovirus to the hGH vector produced a five fold increase in tissue levels relative to the plasmid alone (FIG. 7), but only about a two fold increase in plasma concentration (see, e.g., FIGS. 17 and 18 described above). This lack of proportionality indicates that it is not the concentration of product in the cells alone that determines the rate of secretion into blood, but that at high tissue levels, secretion is limited by other factors. This result is similar to what is observed for endogenous protein secretion and suggests that secretion of the engineered protein is regulated in much the same manner.

Example 19 Comparison of hGH Secretion by Rat Liver, Pancreas, and Combined Liver and Pancreas Transformed with hGH-Encoding DNA

[0181] Eight micrograms of the pFGH.CMV construct premixed with adenovirus as described above, was introduced into the ducts of either the liver, the pancreas, or both organs of the same animal. Where only the liver or the pancreas was transformed (liver alone or pancreas alone), the DNA was introduced according to the methods described above. Where both the liver and pancreas received the formulation, the DNA-containing formulation was introduced into the hepatic duct first, and then the tubing partially withdrawn to provide access to the pancreatic duct system. A temporary ligature was then placed around the hepatic duct to prevent the second infusion from entering the parenchyma of the liver. Thus, animals in which both the pancreas and liver were transformed received two doses of the DNA-containing formulation. Plasma hGH levels were measured two days later.

[0182] In animals having transformed liver (liver alone) or pancreas (pancreas alone), hGH was expressed in liver or pancreatic tissue, respectively, and hGH detected in plasma under both circumstances. Tissue levels in liver when transformed alone were far lower than in the pancreas when transformed alone (less than 1 ng/g, as compared to about 500 ng/g), but hGH concentration in plasma of animals in which only the liver was transformed was nonetheless comparable to hGH plasma levels in animals having only the pancreas transformed (in the range of 0.15 ng/ml; FIG. 24). These results are consistent with the observation that, in contrast to the exocrine cells of the pancreas and salivary glands, hepatocytes secrete most of what they produce soon after synthesis. Thus the liver can provide for substantially constitutive delivery of a polypeptide into the bloodstream.

[0183] When pancreas and liver were both transfected, plasma levels were higher than seen when the glands were treated individually (nearly 0.3 ng/ml)—a value approximately equal to the sum of that observed for the two organs separately. Surprisingly, transformation of both liver and pancreas resulted in tissue levels in the pancreas being significantly increased relative to tissue levels in the pancreas when the pancreas was transformed alone (FIG. 25)

Example 20 In vivo Gene Transfer of DNA Encoding Human Growth Hormone by Retrograde Administration of DNA into the Salivary Gland

[0184] A DNA expression construct encoding human growth hormone (hGH) is prepared by operably linking a CMV promoter to hGH-encoding DNA. The expression cassette is then inserted into a construct such as the bacterial plasmid pBR322. Escherichia coli is then transformed with the plasmid using conventional transformation procedures. E. coli containing the plasmid are selected by virtue of the tetracycline or ampicillin resistance encoded by pBR322, and the transformed bacterial cells propagated in culture. Plasmid DNA is then isolated from the transformed bacterial cell culture and the DNA purified by cesium gradient.

[0185] Approximately 250 μg of the purified plasmid DNA containing hGH DNA is introduced into the salivary gland of a human patient by retrograde ductal administration via a salivary gland duct. Expression and intravenous secretion of the protein is assessed using the method described above.

Example 21 In vivo Gene Transfer of DNA Encoding Human Growth Hormone by Retrograde Ductal Administration of Naked DNA into the Pancreas

[0186] A construct containing hGH-encoding DNA (Marshall et al., Biotechnology 24:293-298, 1992) operably linked to the CMV promoter is resuspended in 0.9% saline and a volume of the DNA solution is administered to a human patient. Approximately 1 mg of DNA is delivered to the pancreas of the patient by cannulation of the pancreatic duct by duodenal intubation using endoscopic retrograde cholangio-pancreatography. Expression and secretion of human growth hormone into the bloodstream is assessed by detection of the protein in the patient's blood.

Example 22 In vivo Gene Transfer of DNA Encoding Human Insulin by Cannulation of Naked DNA into the Liver

[0187] A construct containing human insulin-encoding DNA operably linked to the CMV promoter is resuspended in 0.9% saline and a volume of the DNA solution is administered to a human patient. Approximately 1 mg of DNA is delivered to the patient's liver by cannulation of the hepatic duct. Expression and secretion of human growth hormone into the bloodstream is assessed by detection of the protein in the patient's blood.

[0188] Following procedures similar to those described above, other proteins and gene products can be expressed from DNA inserted in a secretory gland cell according to the invention.

[0189] The invention now being fully described, it will be apparent to one of ordinary skill in the art that many changes and modifications can be made thereto without departing from the spirit or scope of the appended claims. 

What is claimed is:
 1. A method of delivering a protein to the bloodstream of a mammal, the method comprising the step of: introducing a DNA construct into a pancreas cell in vivo, wherein the DNA construct comprises a DNA sequence of interest which encodes a protein and a eukaryotic promoting sequence operably linked to the DNA sequence of interest, wherein the introduced DNA construct is expressed and the protein encoded by the introduced DNA construct is delivered into the blood stream of the mammal.
 2. The method of claim 1, wherein said introducing is by delivery of the DNA construct into a lumen of a pancreatic duct.
 3. The method of claim 1, wherein the DNA construct is not contained within a viral particle.
 4. The method of claim 1, wherein said introducing is by delivery of the DNA construct into a lumen of a pancreatic duct, and the DNA construct is not contained within a viral particle.
 5. The method of claim 1, wherein the protein is insulin.
 6. The method of claim 1, wherein the protein is growth hormone.
 7. The method of claim 1, wherein the protein is clotting factor VIII.
 8. The method of claim 1, wherein the protein is erythropoietin.
 9. The method of claim 1, wherein the mammal is a human and the protein is a human protein.
 10. The method of claim 5, wherein the protein is selected from the group consisting of human growth hormone and human insulin.
 11. A method of delivering a protein to the bloodstream of a mammal, the method comprising the step of: introducing a DNA construct into a liver cell in vivo, wherein the DNA construct comprises a DNA sequence of interest which encodes a protein and a eukaryotic promoting sequence operably linked to the DNA sequence of interest, wherein the introduced DNA construct is expressed and the protein encoded by the introduced DNA construct is delivered into the blood stream of the mammal.
 12. The method of claim 11, wherein said introducing is by delivery of the DNA construct into a lumen of a hepatic duct.
 13. The method of claim 11, wherein the DNA construct is not contained within a viral particle.
 14. The method of claim 11, wherein said introducing is by delivery of the DNA construct into a lumen of a hepatic duct, and the DNA construct is not contained within a viral particle.
 15. The method of claim 11, wherein the protein is insulin.
 16. The method of claim 11, wherein the protein is growth hormone.
 17. The method of claim 11, wherein the protein is clotting factor VIII.
 18. The method of claim 11, wherein the protein is erythropoietin.
 19. The method of claim 11, wherein the mammal is a human and the protein is a human protein.
 20. The method of claim 15, wherein the human protein is selected from the group consisting of human growth hormone and human insulin. 